| NPI | 1386815397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4824) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030083-1) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2019-08-08 |